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September 2, 1974

Unresolved Problem of Treatment of Glioma

JAMA. 1974;229(10):1284-1285. doi:10.1001/jama.1974.03230480012009

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To the Editor.—  Marshall et al (228:1417, 1974) have shown that it is feasible to diagnose malignant gliomas by needle biopsy through a burr hole. Unfortunately, the malignant glioma is a disease that defies treatment, not diagnosis.Modern surgical techniques and improved preoperative preparation with steroids and osmotic agents have allowed extensive surgical resections of malignant gliomas. Several groups have concluded that the most radical operative procedure that is consistent with maintenance of neurological function accomplishes more in terms of survival and better postoperative condition than does a less extensive operation. Bartal et al (Surg Neurol 1:337, 1973) have even reported the value of extensive resection of dominant hemisphere glioblastomas in improving the quality and duration of survival. The risk of taking a greater amount of tumor tissue is usually more than compensated for by the beneficial effects of the decompression or tumor removal.Although subtotal resection does not "cure"